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Summary page

Psychiatry

REVIEW PANEL COMPOSITION

The panel was composed of two co-chairs with expertise in the provincial privileging dictionaries and

7 subject matter experts, who work across 6 of the province’s health authorities and with

representation from the Doctors of BC.

RECORD OF REVIEW PANEL DECISIONS AND CRITERIA IDENTIFIED

Below are panel decisions and/or criteria identified to guide discussion of clinical practice and standards.

1. Improve the usability and flow of the document

The original version of psychiatry dictionary had the same content repeated multiple times

throughout the document which caused confusion and was challenging to navigate. The panel

has tightened up the document by grouping similar content together and removing repetition.

2. Removal of general psychiatry non-core privileges

As part of tightening up the document, the panel agreed to remove three general psychiatry non-

core privileges for child and adolescent, geriatric and forensic. General psychiatrists who work

with these population groups are still qualified to care for those patients, as general psychiatrists

by definition work with patients across the lifespan.

3. Update requirements for Methadone prescribing to align with the new guidelines

The panel referred to the new guidelines published June 2017. BC Centre on Substance Use has a

new provincial program that will oversee the methadone maintenance for opioid use.

4. Revised criteria for non-core Electroconvulsive therapy (ECT) privilege

The original criteria restricted qualified training programs to those in Canada and the United

States. The panel was in agreement to broaden the criteria to accept proof of training and letter

of recommendation from other jurisdictions, as acceptable to the appropriate medical leader

5. Engage experts to define criteria for new non-core privileges

Two new privileges are transcranial magnetic stimulation and polysomnography. The panel

reviewed and accepted criteria proposed by sub-committees of subject-matter experts. The

panel made the decision not to include ketamine infusions for treatment of refractory depression

at this point in time, as it has not been used extensively.

The Psychiatry dictionary was approved by PMSEC on 12 April 2018

Summary page

Psychiatry

Overall

Decision / Revision: Restructure content to improve the usability and flow of the document

Engagement Method: Panel discussion

ORIGINAL REVISION

Dictionary is separated into sections for each psychiatry sub-specialty, with repeated qualification content Some non-core privileges are repeated multiple times throughout the documents

General Psychiatry non-core privileges: Licensed prescribing

General Psychiatry non-core privileges: Electroconvulsive therapy (ECT)

C1: Present all definitions and core privileges at the beginning of the document C2: Rearrange the document to eliminate duplication of privileges listed in this dictionary

Non-core privileges: Methadone prescribing for opioid dependence

Non-core privileges: Electroconvulsive therapy (ECT)

Non-core privileges

Decision / Revision: New non-core privileges

Engagement Method: Subject matter experts and panel discussion

ORIGINAL REVISION

Not applicable C3: Two new non-core privileges have been added to Psychiatry dictionary

Non-core privilege: Transcranial magnetic stimulation (TMS)

Non-core privilege: Polysomnography

Psychiatry Clinical Privileges

This dictionary is copyright protected 04-2018 PHSA. For information contact [email protected]. 1

Name:

Effective from: ______/______/________to______/______/________

❏ Initial privileges (initial appointment)

❏ Renewal of privileges (reappointment)

All new applicants must meet the following requirements as approved by the governing body, effective: April 12, 2018

Instructions:

Applicant: Check the “Requested” box for each privilege requested. Applicants are responsible

for producing required documentation to allow for a proper evaluation of current skill, current

clinical activity, and other qualifications and for resolving any doubts related to qualifications for

requested privileges. Please provide this supporting information by uploading the appropriate

documents. Privileges should not be requested (checked off) and cannot be granted unless the

specific criteria associated with the privilege are met.

Medical/Clinical leaders: Check the appropriate box for recommendation on the last page of

this form and include your recommendation for any required evaluation. If recommended with

conditions or not recommended, provide the condition or explanation on the last page of this

form.

Current experience: Current experience thresholds suggested in this document were

developed by practitioners in the field, and are not intended as a barrier to practice or to service

delivery. They are not intended as rigid cut offs, below which clinical privileges must be

restricted or removed. Instead, medical/clinical leaders are encouraged to initiate discussions

with those practitioners who are close to or below the thresholds, to ensure that mechanisms

are in place to ensure adequate practitioner experience and patient outcomes.

Other requirements: Note that even if applicants meet skill or experience requirements, each

site will determine if the requested privilege can be supported at that site. Privileges granted

may only be exercised at the site(s) and/or setting(s) that have sufficient space, equipment,

staffing, and other resources required to support the privilege.

This document is focused on defining qualifications related to training and current experience to

exercise clinical privileges. The applicant must also adhere to any additional organizational,

regulatory, or accreditation requirements that the organization is obligated to meet.

Context: The care of patients presenting with complex problems or uncommon diseases

requires access to multidisciplinary groups, experienced teams and institutions with the

necessary subspecialties and infrastructure for appropriate care.

Grandparenting: Practitioners holding privileges prior to implementation of the dictionary will

continue to hold those privileges as long as they meet current experience and quality

requirements.

mailto:%[email protected]



Continuous Professional Development (CPD): Where suggested in this document, CPD

requirements reflect those professional development activities which are eligible for:

1. credit under the Royal College of Physicians and Surgeons of Canada’s (Maintenance of

Certification (MOC) program;

2. the College of Family Physicians of Canada Mainpro+;

3. those professional development activities held in foreign jurisdictions which would be

eligible under the MOC/Mainpro program if held in Canada; or

4. equivalent CPD or Quality Assurance activities for other practitioners.

Planned vs. Unplanned (Emergency) Care: The scope of privileges granted to any individual

practitioner is based on considerations of patient care under “normal circumstances.” In the

setting of risk to life or limb, the rules of privilege are not meant to constrain practitioners from

acting in the best interest of a patient.

Note: The dictionary will be reviewed over time to ensure it is reflective of current practices,

procedures and technologies.

Core privilege: Types of activities a recent graduate of the discipline can reasonably be

expected to perform at a specific facility. Under core privileges in this dictionary, if there is a

procedure you wish to NOT perform please type into the Comments field.

Non-core privilege: Types of activities that require further training, experience and

demonstrated skill. Non-core privileges are requested in addition to requesting core. Individuals

requesting these privileges should meet the specific threshold criteria associated to such non-

core privileges.

Context specific privileges: Privileges that take into account what medical services and

procedures a facility can support.

Additional privilege: An additional privilege is any privilege that is not included in the core,

non-core, or context-specific privileges dictionary for your discipline. Additional privileges

already listed in this document were previously requested by others who practice in your

discipline; they may or may not be relevant to you. If there are any privileges not listed in your

dictionary that you wish to request, please complete an additional privilege request form and

attach any evidence of training to support your request.

Restricted procedures: Some dictionaries have procedures identified by the Ministry of Health

as [DESIGNATED A RESTRICTED SERVICE BY THE MEDICAL SERVICES COMMISSION].

Privileges identified as restricted procedures may be flagged in this document. Where it

appears, the restricted procedures flag is for administrative tracking only, and has no impact on

clinical content.




Definition for General Psychiatry

Psychiatry is the branch of medicine concerned with the practice of biopsychosocial

assessment, diagnosis, treatment, rehabilitation and prevention of mental (cognitive, emotional

and behavioral/addictive) disorders alone or as they coexist with other medical or surgical

disorders across the life span and in a variety of settings.

Definition for Child and Adolescent Sub-specialty Psychiatry

Child and Adolescent Psychiatry is a branch of medicine and a subspecialty of psychiatry

concerned with the biopsychosocial approach to etiology, assessment, diagnosis, treatment and

prevention of developmental, emotional and behavioral disorders from infancy through

adolescence alone or as they coexist with other medical disorders.

Definition for Geriatric Sub-specialty Psychiatry

Geriatric Psychiatry, a psychiatry subspecialty, focuses on the assessment, diagnosis and

treatment of complex mental disorders uniquely occurring in late life. Geriatric Psychiatry is

focused on providing care for intensive-needs patients and their caregivers at the end of life

cycle, a time when many complex physical and mental health issues coalesce. Geriatric

Psychiatry organizes service delivery of psychiatric care to elderly in multidisciplinary teams and

in locations that best serve the needs of this elderly population. Geriatric Psychiatry is engaged

in advocacy and development of health policy and planning related to late-life mental illness and

mental health, caregiver and care provider support, and systems of care.

Definition for Forensic Sub-specialty Psychiatry

Forensic Psychiatry is a psychiatric subspecialty in which scientific and medical expertise are

applied to legal issues in legal contexts embracing civil, criminal, correctional and legislative

matters. Forensic Psychiatrists also have specialized expertise in the assessment and

treatment of special populations, including young offenders, sexual offenders and violent

offenders.




Qualifications for General Psychiatry, Child and Adolescent and

Geriatric, Forensic sub-specialties*

Initial privileges: To be eligible to apply for privileges in psychiatry, the applicant should meet

the following criteria:

Current certification in Psychiatry by the Royal College of Physicians and Surgeons of Canada

OR

Recognition of certification as a Psychiatrist by the College of Physicians and Surgeons of

British Columbia by virtue of credentials earned in another jurisdiction that are acceptable to

both the College and the governing body of the the Health Authority and its Affiliate(s).

*AND (Only applicable to applicants who practice as Child and Adolescent, Geriatric, and/or

Forensic sub-specialties.)

*Complete additional enhanced training relevant to scope of privilege requested, which could

include sub-specialty training accredited by or acceptable to the RCPSC, or practice eligibility

recognition as currently defined by the RCPSC.

AND

Recommended current experience: Demonstrated current competence and evidence of an

appropriate volume of patient encounters acceptable to the appropriate medical leader during

the past 24 months, or completion of training in the past 24 months.

Renewal of privileges: Demonstrated current competence, continuing professional

development and evidence of an appropriate volume of patient encounters acceptable to the

appropriate medical leader during the past 36 months and based on results of ongoing

performance reviews.

Return to practice: Three to six months of supervision, at the discretion of the appropriate

medical leader; additional training may be recommended.

Core privileges: Psychiatry

Core privileges are offered to ALL members in the discipline as long as the facility can support

those activities.

❑ Requested: General Psychiatry – see below for description

❑ Requested: Child and Adolescent Psychiatry (subspecialty practice) – see below for

description

❑ Requested: Geriatric Psychiatry (subspecialty practice) – see below for description

❑ Requested: Forensic Psychiatry (subspecialty practice) – see below for description




Core privileges: General Psychiatry

Evaluate, diagnose, treat, and provide consultation to patients across the lifespan in a variety of

settings presenting with mental disorders. Privileges include providing: consultation to clinicians

and/or third parties (e.g. attorneys, schools, insurers) regarding mental disorders;

pharmacotherapy; psychotherapy; psychoeducation; and the ordering of diagnostic and/or

laboratory tests. This may include a relevant physical exam. Assess, stabilize, and determine

the disposition of patients with emergent conditions consistent with medical staff policy

regarding emergency and consultative call services.

The core privileges in this specialty contain assessments including but not limited to:

Diagnostic interview

Cognitive screen

Risk assessment of harm to self or others

Capacity (e.g. treatment, financial, personal care)

Core privileges: Child and Adolescent Sub-specialty Psychiatry

Evaluate, diagnose, treat, and provide consultation to child and adolescent patients and their

families presenting with mental disorders. Privileges include providing: consultation to clinicians

and/or third parties (e.g. attorneys, schools, insurers) regarding mental disorders;





The core privileges in this sub-specialty contain assessments including but not limited to:

Capacity to consent

Cognitive/Developmental screen



Core privileges: Geriatric Sub-specialty Psychiatry

Evaluate, diagnose, treat, and provide consultation to older adult patients and their families

presenting with mental disorders. Privileges include providing: consultation to clinicians and/or

third parties (e.g. Public Trustee, Superintendent of Motor Vehicles, attorneys, , insurers)

regarding mental disorders; pharmacotherapy; psychotherapy; psychoeducation; and the

ordering of diagnostic and/or laboratory tests. This may include a relevant physical exam.

Assess, stabilize, and determine the disposition of patients with emergent conditions consistent

with medical staff policy regarding emergency and consultative call services. May provide care

to patients in inpatient, ambulatory, ordomiciliary care setting in conformance with Health

Authority policies






Complete cognitive assessments


Capacity assessments (e.g. treatment, financial, personal care)

Core privileges: Forensic Sub-specialty Psychiatry

Evaluate, diagnose, treat, and provide consultation to persons with mental disorders who are in

conflict with the law and/or associated legal involvement. Privileges include providing:

assessment and/or treatment services for the courts, the Criminal Code Review Board,

clinicians and/or third parties (e.g. attorneys, schools, insurers) regarding mental disorders;








Cognitive screen

Capacity assessments (e.g. treatment, financial, personal care)

AND

The procedures on the attached procedures list as well as such other procedures that are

extensions of the same techniques and skills.

General Psychiatry, Child and Adolescent Psychiatry, Geriatric Psychiatry,

Forensic Psychiatry - Core Procedures List

This is not intended to be an all-encompassing procedures list. It defines the types of

activities/procedures/privileges that recently graduated residents in this specialty perform at this

organization would competently perform and inherent activities/ procedures/ privileges requiring

similar skill sets and techniques.

To the applicant: If there is a procedure you wish to NOT perform, then please type into the

Comments field.

Core procedures for all psychiatrists

Intervention Pharmacotherapy Psychotherapies including

o Supportive therapy o Crisis intervention and de-escalation




Additional Core Procedures for Forensic Psychiatrists

Assessment for court (fitness to stand trial, criminal responsibility)

Specialized risk assessment for general violence

Writing forensic psychiatric reports and providing expert opinion to the court and the Criminal Code Review Board

Core privileges: Admitting Privileges

❑ Requested: Full Admitting – General Psychiatry

❑ Requested: Full Admitting – Child and Adolescent Psychiatry

❑ Requested: Full Admitting – Geriatric Psychiatry

❑ Requested: Full Admitting – Forensic Psychiatry

Non-core privileges: Methadone prescribing for opioid dependence

❑ Requested

Initial privileges/ Renewal/ Return to Practice: Compliance with the College of Physicians

and Surgeons of British Columbia (CPSBC) Practice Standard – Prescribing Methadone with

regard to the treatment of opioid dependence.

Continuation of an established prescription for inpatients during hospitalization is a core privilege.

Non-core privileges: Electroconvulsive therapy (ECT)

❑ Requested

Initial privileges: Proof of ECT training

Successful completion of ECT training as part of accredited residency in psychiatry or

equivalent training acceptable to an appropriate medical leader.

OR

Letter of recommendation for members moving from another jurisdiction :

Non-core privileges (see specific criteria)

Are permits for activities that require further training, experience and demonstrated skill

Are requested individually in addition to requesting the core

Each individual requesting non-core privileges should meet the specific threshold criteria as outlined




Describing ECT competency from a psychiatrist who is a practicing ECT clinician and who has

observed and reviewed their ECT practice within the past year. The number of observed ECT

deliveries will be at the discretion of the supervising ECT clinician or their designate at that

centre.

OR

Demonstration of skill and discussion of indications/contraindications in ECT with a member of

the medical staff of a facility that routinely provides or teaches ECT. .

AND

Recommended current experience: Delivery of 16 individual ECT treatments per year,

averaged over the previous 24 months

Renewal of privileges: Delivery of 16 individual ECT treatments per year, averaged over the

previous 36 months

Return to practice:

Recent attendance of approved ECT Course to the satisfaction of the appropriate medical

leader.

OR

Complete a personal learning project (minimum 6 hours) with a current privileged department

member.

AND

Supervision of independent delivery of at least 4 ECT treatments by a privileged ECT member

or designate. One of these treatments should be the initial ECT treatment for a patient in order

to demonstrate the principles of dose titration.

Non-core privileges: Transcranial magnetic stimulation (TMS)

❑ Requested

Definition

Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to

stimulate nerve cells in the brain to improve symptoms of depression.

Initial privileges: Proof of TMS training

Successful completion of an accredited TMS clinical training program in the past 5 years with a

component of the training devoted to operating the device

AND




Recommended current experience: Delivery of at least 1 rTMS treatment course in the past

year, including motor threshold determination

OR

Proof of TMS training

Successful completion of an accredited TMS clinical training program in the past 5 years with a

component of the training devoted to operating the device

AND

Recommended current experience: If not having delivered at least one rTMS course

independently in the past year, then the delivery of at least 1 rTMS treatment course under the

supervision of a privileged TMS practitioner, including direct observation by the supervisor of the

motor threshold determination session AND a review of the local site’s indications,

contraindications, consent and device parameters for TMS by the supervising privileged TMS

practitioner

Renewal of privileges: Successful completion of an accredited TMS training program every 5

years with a component of training devoted to operating the device

AND

Delivery of at least 1 rTMS treatment course over the past year

Return to practice: (away from rTMS for 5 or more years)

Proof of TMS training

Successful completion of an accredited TMS clinical training program with a component of the

training devoted to operating the device

AND

Delivery of at least 1 rTMS treatment course under the supervision of a privileged TMS

practitioner, including direct observation by the supervisor of the motor threshold determination

session AND a review of the local site’s indications, contraindications, consent and device

parameters for TMS by the supervising privileged TMS practitioner

Non-core privileges: Polysomnography

[DESIGNATED A RESTRICTED SERVICE BY THE MEDICAL SERVICES COMMISSION]

❑ Requested

Definition

Polysomnography consists of a simultaneous recording of multiple physiologic parameters

related to sleep and wakefulness. As a minimum, recording must include

electroencephalography (EEG), electrooculography (EOG), surface electromyography (EMG),




and airflow monitoring. Other parameters may also be monitored, such as electrocardiography,

Pulse oximetry, respiratory effort (thoracic and abdominal), end tidal or transcutaneous CO2,

sound recordings to measure snoring, and surface EMG monitoring of limb muscles (to detect

limb movements, periodic or other).

Initial privileges: Successful completion of a Royal College (or equivalent, e.g. American Board

of Sleep Medicine) postgraduate training program in Sleep Medicine OR completion of a clinical

fellowship or equivalent training in a recognized Sleep Medicine training centre that includes

training in the supervision of polysomnographic technologists, quality assurance of

polysomnographic equipment and reports, scoring, interpretation and reporting of

polysomnographic and related studies including multichannel ambulatory sleep studies.

Alternative training options may become available in future.

For interpretation of multichannel ambulatory sleep studies alone, candidates must demonstrate

adequate training during their fellowship or in a recognized sleep training centre or course, and

have interpreted 50 such studies during the training process.

Recommended current experience:

Demonstrated current skill and evidence of supervision and reporting of 50 polysomnograms or

related studies within the past 12 months.

Renewal of privileges:

Demonstrated current skill and evidence of performance of 150 polysomnograms or related

studies over 36 months.

Return to practice: Complete a personal learning project with a current privileged department

member to the satisfaction of the appropriate medical leader.

Non-core privileges: Specialized risk assessments

Specialised Risk assessment (spousal and sexual violence, stalking)

❑ Requested

Initial privileges: Completed training, acceptable to the appropriate medical leader, in

conducting specialized forensic risk assessments.

Where the applicant has not had any training, or has had training but of such quality and/or

duration as to be unacceptable to the appropriate medical leader, the applicant is willing and

able to undergo training to a standard acceptable to the appropriate medical leader and accepts

that the privilege will be deferred until successful completion of training.

AND




Recommended current experience: Applicant has conducted a number of specialized forensic

risk assessments of sufficient quality to be acceptable to the appropriate medical leader.

Renewal of privileges: Practice forensic psychiatry conducting a number of specialized risk

assessments of a quality acceptable to the appropriate medical leader.

Return to practice: Completion of specialized risk assessments under supervision for a period

and to a standard acceptable to the appropriate medical leader.

Non-core privileges: Specialized diagnostic assessment

(Psychopathy)

❑ Requested

Initial privileges:

1. Completed training, acceptable to the appropriate medical leader, in the diagnosis of

psychopathy

2. Where the applicant has not had any training, or has had training but of such quality and/or

duration as to be unacceptable to the appropriate medical leader, the applicant is willing and

motivated to undergo training to a standard acceptable to the appropriate medical leader

and accepts that the privilege will be deferred until successful completion of training.

AND

Recommended current experience: Applicant has conducted a number of psychopathy

diagnostic assessments of sufficient quality to be acceptable to the appropriate medical leader.

Renewal of privileges: Completed a number of psychopathy diagnostic assessments of a

quality acceptable to the appropriate medical leader

Return to practice: Completion of psychopathy diagnostic assessments under supervision for

a period and to a standard acceptable to the appropriate medical leader.




Additional privileges

Definition: An additional privilege is any privilege that is not included in the core, non-core, or

context-specific privileges dictionary for your discipline.

Instructions

On the additional privilege request form, you’ll be asked to provide the following details:

a) the privilege requested (the procedure or activity you are requesting)

b) the site or facility where the privilege would be exercised, and

c) your relevant training, experience or certification, if applicable.

Your request for additional privileges will be submitted to your medical leader. Please note that

additional privileges are not automatically granted, but are reviewed to determine alignment with

the site capacity and to ensure training requirements are met.

The privileging dictionaries on this site (bcmqi.ca) are the official versions.

Dictionary content will be updated as according to the review schedule posted at the bcmqi.ca

dictionary review hub. You can provide input on a dictionary at any time, by submitting a

Dictionary Feedback form to the BC MQI office.

Dictionary content and feedback

To request a privilege that is not included in the core, non-core, or context specific

privileges for your discipline, notify your medical leader or local credentialing office.

A credentialing coordinator will send you an additional privilege request form to complete.


http://bcmqi.ca/

http://bcmqi.ca/credentialing-privileging/dictionaries/dictionary-review-hub

http://bcmqi.ca/dictionary-feedback



I have requested only those privileges for which by education, training, current experience, and

demonstrated performance I am qualified to perform and for which I wish to exercise at the

facility I am applying, and I understand that:

a. In exercising any clinical privileges granted, I am constrained by hospital and

medical staff policies and rules applicable generally and any applicable to the

particular situation.

b. Any restriction on the clinical privileges granted to me is waived in an emergency

situation, and in such situation my actions are governed by the applicable section of the

medical staff bylaws or related documents.

Signed: ____________________________ Date: _____________________________

I have reviewed the requested clinical privileges and supporting documentation for the above-

named applicant and:

❑ Recommend all requested privileges

❑ Recommend privileges with the following conditions/modifications:

❑ Do not recommend the following requested privileges:

Privilege condition/ modification/ explanation

Notes:

Name of Department / Division/ Program/ Facility:

Name of Medical Leader:

Title:

Signature:

Date:

Acknowledgement of Practitioner

Medical / Clinical Leader’s Recommendation

S


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